HomeMy WebLinkAboutX2020-2675 - Permit Application (2)Print Form Worksheet for Combo Bui.aing & Solar Pei rniit a. pi:�a 1 on ° R>
j- Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI I IAA +"
Building Grading F-Drainage j- Elec F- Mech
r Plum Cu vd cut Cu Yd Fill
Project Address (Not mailing_ address) F- Flood
F- Fire Miq F- Landslide F-N/A Floor Suite No
--
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rA1,6
Description of Work
�. L—
Use F— ConstType
# Stories #Units (if Res)
Valuation
New/Add SF Remodel SF Gara
a/New/Add
g F—
Material/Labor
OWNER'S NAME Last
First}t^
Owner's Address
Owner's E-mail Address
t k4
City State F®
Zip — Telephoned
APPLICANT'S NAME Last F
First
Applicant's Address
Applicant's E-mail Address
City � State F—
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last f ff6 7rP QA41 First ig({ M Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City F State r®®®
I
Zip F Telephoned
ENGINEER'S NAME Last
First �— Lic. NoT
Engineer's Address
Engineer's E-mail Address
City State F
Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- Class
Contractor's Address
Contractor's E-mail Address
City State F
—
Zip F TelephoneF
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETR� CKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
' �1 MM MM ,�J�,�
USE 7r�NE _ DEVELOPMENT NO � GL'>7�W'� Vi'(UT PLAN CHECK FEES $